NPIMap

Organization Active NPI

Impact Behavioral

  • Community/Behavioral Health Agency
  • Marrero, LA
National Provider Identifier
1053770685
Registry record updated Feb 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
IMPACT BEHAVIORAL
Practice address
4700 Wichers Dr
Suite 205
Marrero, LA 70072-3041
Phone
(504) 407-0709
Fax
(504) 333-6252
NPI assigned
Feb 10, 2016
Last updated
Feb 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mieshan Madison, MANPI 1639536469
Title
Clinician
Phone
(504) 394-1774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LA Primary

Addresses

Primary practice location

4700 Wichers Dr
Suite 205
Marrero, LA 70072-3041

Mailing address

4700 Wichers Dr
Suite 205
Marrero, LA 70072-3041
Phone (504) 407-0709

National Provider Directory

National Provider Directory
Tax ID family
Impact Behavior Health Service3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1053770685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WICHERS DR",
            "address_2": "SUITE 205",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723041",
            "telephone_number": "504-407-0709",
            "fax_number": "504-333-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WICHERS DR",
            "address_2": "SUITE 205",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723041",
            "telephone_number": "504-407-0709",
            "fax_number": "504-333-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIORAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "MADISON",
        "authorized_official_first_name": "MIESHAN",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "504-394-1774",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.